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    <title>Transport Research International Documentation (TRID)</title>
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    <copyright>Copyright © 2026. National Academy of Sciences. All rights reserved.</copyright>
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    <managingEditor>tris-trb@nas.edu (Bill McLeod)</managingEditor>
    <webMaster>tris-trb@nas.edu (Bill McLeod)</webMaster>
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      <title>Transport Research International Documentation (TRID)</title>
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      <title>Costs Associated With Helmet Use in Motorcycle Crashes: The Cost of Not Wearing a Helmet</title>
      <link>https://trid.trb.org/View/1143691</link>
      <description><![CDATA[The relationship between injuries sustained in a motorcycle crash (MCC) by unhelmeted motorcyclists and the multitude of costs associated with those injuries has been a decades-long debate. Results from research addressing injuries and mortality due to helmet use in MCCs demonstrates that unhelmeted motorcyclists experience more severe injuries, resulting in higher health care costs and an increased likelihood of requiring care beyond the hospital in other facilities. However, a link between injury severity and hospital costs has not been established with its spillover effect onto health insurance providers. This retrospective study was designed to delineate the health care and insurance costs of adult trauma patients admitted to a Level 1 trauma center due to an MCC. The study included adult trauma patients 18 years of age or older admitted to a Level 1 trauma center due to an MCC between January 1, 2005, and December 31, 2010. The center is a receiving hospital for the central third of a Midwestern state, serving a medium-sized city as well as rural and isolated population areas. Patients were stratified into 2 groups based on helmet use. Patient variables included mechanism of injury, clinical characteristics, total units of blood used, intensive care unit (ICU) length of stay (LOS), hospital LOS, days on a ventilator, mortality, number of procedures during hospital stay, primary payor, discharge location, and total hospital charges. A linear regression model was used to predict the charges associated with the severity of injuries. A significant difference was found for total hospital charges. The mean total hospital charge for helmeted patients was $4184.26 compared to $7383.31 for unhelmeted patients. The prediction model was statistically significant, indicating that not wearing a helmet starts the patient at a cost of $3199.06. The cost of treatment for patients who wore helmets was $256.93 for each incremental increase in Injury Severity Score (ISS) compared to $537.57 for unhelmeted patients. ICU LOS, hospital LOS, and vent days were statistically significant, with durations longer for unhelmeted patients. Helmeted patients also required more units of blood. The total number of procedures for each patient approached significance, with the unhelmeted group requiring more procedures. The goal of the study was to delineate the medical costs associated with helmet use and nonuse in motorcyclists. The results demonstrate that medical costs due to an MCC for an unhelmeted motorcyclist were significantly higher than for a helmeted motorcyclist. These costs were paid by providers of health insurance, mainly Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), Medicaid, and commercial insurance.]]></description>
      <pubDate>Fri, 27 Jul 2012 10:07:01 GMT</pubDate>
      <guid>https://trid.trb.org/View/1143691</guid>
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    <item>
      <title>Costs of Crashes to Government, United States, 2008</title>
      <link>https://trid.trb.org/View/1122643</link>
      <description><![CDATA[This paper, from a conference on crash injury control, reports on a study that estimated how much the Federal government and state/local government pay for different kinds of crashes in the United States.  The authors considered government costs to include reductions in an array of public services (emergency, incident management, vocational rehabilitation, coroner court processing of liability litigation), medical payments, social safety net assistance to the injured and their families, and taxes foregone because victims miss work. Government also pays when its employees crash while working and covers fringe benefits for crash-involved employees and their benefit-eligible dependents in non-work hours.  The authors then applied their estimates to existing US Department of Transportation estimates of crash costs to society and employers. The data showed that government pays an estimated $35 billion annually because of crashes, which represents an estimated 12.6% of the economic cost of crashes (Federal 7.1%, State/local 5.5%). Government bears a higher percentage of the monetary costs of injury crashes than fatal crashes or crashes involving property damage only. The authors conclude with a discussion of whether return on investment is an appropriate government crash safety investment objective.  While government is increasingly recovering the medical cost of crashes from auto insurers, medical costs and income and sales tax losses account for 75% of government's crash costs.]]></description>
      <pubDate>Tue, 29 Nov 2011 13:44:06 GMT</pubDate>
      <guid>https://trid.trb.org/View/1122643</guid>
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    <item>
      <title>Average out-of-pocket healthcare and work-loss costs of traffic injuries in Karachi, Pakistan</title>
      <link>https://trid.trb.org/View/1116512</link>
      <description><![CDATA[The objective of this study was to assess the average out-of-pocket healthcare and work-loss costs of road traffic injuries (RTI) in Karachi. In this cross-sectional study, RTI patients presenting to the five trauma centres in Karachi were contacted using stratified sampling to report their inpatient and outpatient expenses, the time spent in hospital and their average monthly income. These costs were compared among different categories of patient-related variables using analysis of variance test. Out of 341 RTI victims, two wheelers accounted for the majority of injuries (77.2%, N = 256) followed by pedestrians (14.2%, N = 48). Almost half of the sample patients were breadwinners (N = 135, 45.2%), with 87.4% (N = 118) earning less than US$ 248. Average out-of-pocket healthcare costs were US$ 271 (SD = 440.9), which were significantly higher (P = 0.026) for pedestrians (US$ 442), moderate (US$ 341.7) or severe (US$ 553.8) injury, and treatment in private hospitals (US$ 451.7). Similarly, average work loss was US$ 67.1 (SD = 132.1), which were significantly higher (P = 0.001) for breadwinners (US$ 99.1), moderate (US$ 130.0) or severe (US$ 157.1) injury, and treatment in private hospitals (US$ 150.0). Study results clearly showed the need to advocate RTI prevention measures in Pakistan as any such event could lead to a difficult economic situation for those involved and their family.]]></description>
      <pubDate>Tue, 27 Sep 2011 08:16:33 GMT</pubDate>
      <guid>https://trid.trb.org/View/1116512</guid>
    </item>
    <item>
      <title>Medical and Economic Cost of North Dakota Motor Vehicle Crashes</title>
      <link>https://trid.trb.org/View/927272</link>
      <description><![CDATA[Each year there are more than 16,000 motor vehicle crashes (MVCs) on North Dakota roadways, resulting in more than 2,900 injuries and 107 fatalities. Understanding the economic impacts of these MVCs is important in discerning impacts of road investments, behaviors, and policy changes that affect public safety. Total economic costs are estimated for MVCs in the state, with detail provided on medical costs borne by taxpayers. The present value of costs for MVC injuries incurred over a seven year period is estimated to better understand benefits, in terms of cost avoidance, for investment in traffic safety. Looking at the economic costs of MVCs and using a benefit/cost analysis of implementing a primary seatbelt law produces a savings from $90 million to $277 million over the seven-year period. The medical cost savings to Medicaid alone could be as little as $1 million and as high as $3 million, and the savings to all medical insurers ranges from $8.4 million to $25.3 million.]]></description>
      <pubDate>Fri, 27 Aug 2010 16:25:07 GMT</pubDate>
      <guid>https://trid.trb.org/View/927272</guid>
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    <item>
      <title>Estimated Medical Cost Savings in Massachusetts by Implemention of a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/897743</link>
      <description><![CDATA[This report examines 2006 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Massachusetts if a primary seat belt law is implemented.  The savings are calculated using costs based on the report "Economic Impact of Motor Vehicle Crashes" (DOT HS 809 446).  In Massachusetts, there is an expectation of a primary law reducing the burden of insurance companies by about $55.8 million from crashes occurring in a single year alone.  The crash victims in Massachusetts would benefit by a reduction of about $3.9 million while the Federal Government would also reduce its costs by about $3.9 million before reimbursing Massachusetts for a portion of Medicaid Expenditures.  Massachusetts would also reduce its spending by $5.7 million ($3.6 million after reimbursement).]]></description>
      <pubDate>Mon, 03 Aug 2009 15:27:20 GMT</pubDate>
      <guid>https://trid.trb.org/View/897743</guid>
    </item>
    <item>
      <title>Estimated Medical Cost Savings in Nevada by Implementation of a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/894602</link>
      <description><![CDATA[This report examines 2007 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Nevada if a primary seat belt law is implemented. The savings are calculated using costs based on the report "Economic Impact of Motor Vehicle Crashes" (DOT HS 809 446). In Nevada, there is an expectation of a primary law reducing the burden of insurance companies by about $4.2 million from crashes occurring in a single year alone. The crash victims in Nevada would benefit by a reduction of more than $503,000 while the Federal Government would reduce its costs by about $543,000 before reimbursing Nevada for a portion of Medicaid expenditures. Nevada would also reduce its spending by $1.6 million ($930,000 after reimbursement).]]></description>
      <pubDate>Mon, 20 Jul 2009 16:50:26 GMT</pubDate>
      <guid>https://trid.trb.org/View/894602</guid>
    </item>
    <item>
      <title>Estimated Medical Cost Savings in Rhode Island by Implementation of a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/894608</link>
      <description><![CDATA[This report examines 2006 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Rhode Island if a primary seat belt law is implemented. The savings are calculated using costs based on the report "Economic Impact of Motor Vehicle Crashes" (DOT HS 809 446). In Rhode Island, there is an expectation of a primary law reducing the burden of insurance companies by about $1.9 million from crashes occurring in a single year alone. The people of Rhode Island would benefit by a reduction of more than $397,000 while the Federal Government would reduce its costs by about $278,000 before reimbursing Rhode Island for a portion of Medicaid expenditures. Rhode Island would also reduce its spending by $553,000 ($374,000 after reimbursement).]]></description>
      <pubDate>Mon, 20 Jul 2009 16:50:25 GMT</pubDate>
      <guid>https://trid.trb.org/View/894608</guid>
    </item>
    <item>
      <title>Estimated Medical Cost Savings in Vermont by Implementation of a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/894612</link>
      <description><![CDATA[This report examines 2005 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to the State of Vermont if a primary seat belt law is implemented. The savings are calculated using costs based on the report "Economic Impact of Motor Vehicle Crashes" (DOT HS 809 446). In Vermont, there is an expectation of a primary law reducing the burden of insurance companies by about $1.3 million from crashes occurring in a single year alone. The people of Vermont would benefit by a reduction of more than $130,000 while the Federal Government would reduce its costs by about $125,000 before reimbursing Vermont for a portion of Medicaid expenditures. Vermont would also reduce its spending by more than $498,000 ($248,000 after reimbursement).]]></description>
      <pubDate>Mon, 20 Jul 2009 16:50:25 GMT</pubDate>
      <guid>https://trid.trb.org/View/894612</guid>
    </item>
    <item>
      <title>Estimated Medical Cost Savings in New Hampshire by Implementation of a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/867563</link>
      <description><![CDATA[This report examines 2005 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to the State of New Hampshire if a primary seat belt law is implemented. The savings are calculated using costs based on the report "Economic Impact of Motor Vehicle Crashes" (DOT HS-809 446). In New Hampshire, there is an expectation of a primary law reducing the burden of insurance companies by about $5.1 million from crashes occurring in a single year alone. The citizens of New Hampshire would benefit by a reduction of $1.2 million while the Federal Government would reduce its costs by $1.2 million. The State of New Hampshire would also reduce its spending by more than $400,000.]]></description>
      <pubDate>Fri, 08 Aug 2008 15:46:17 GMT</pubDate>
      <guid>https://trid.trb.org/View/867563</guid>
    </item>
    <item>
      <title>Estimated Minimum Savings to the Medicaid Budget in Florida by Implementing a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/855907</link>
      <description><![CDATA[A 2003 study estimated that if all States had primary laws from 1995 to 2002, over 12,000 lives would have been saved. Failure to implement a primary belt law creates a real cost to a State’s budget for Medicaid and other State medical expenditures. This study estimates the minimum dollars Florida can expect to save on direct medical costs (primarily paid through Medicaid) by the implementation of a primary seat belt law. The current study analyzed Florida’s 2005 Hospital Discharge Data, including only cases where the external cause of injury was a motor vehicle crash. The total estimated costs to Medicaid, including Traumatic Brain Injury and Spinal Cord Injury costs, from motor vehicle crashes for the first year the injury was incurred for Florida is $105.5 million for the first year and $21.4 million for each year after. In 2005, Florida’s seat belt use rate was 73.9%. Based on the conversion rate one would expect belt use to increase by 10.44% and of those newly belted individuals, at least 50% would avoid injury (based on seat belt effectiveness in reducing injury). The 2005 Federal Government reimbursement rate for Florida’s Medicaid expenditures was 58.76%. Accounting for this reimbursement, the first-year savings to the State by implementation of a primary seat belt law would be about $2.3 million dollars. By the fifth year, the savings would be $4.1 million for that year alone. Florida could expect to save $15.9 million in the first 5 years and $43.1 million over 10 years.]]></description>
      <pubDate>Fri, 02 May 2008 16:15:28 GMT</pubDate>
      <guid>https://trid.trb.org/View/855907</guid>
    </item>
    <item>
      <title>Estimated Minimum Savings to the Medicaid Budget in Colorado by Implementing a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/855906</link>
      <description><![CDATA[A 2003 study estimated that if all States had primary seat belt laws from 1995 to 2002, over 12,000 lives would have been saved. Failure to implement a primary seat belt law creates a real cost to a State’s budget for Medicaid and other State medical expenditures. This study estimates the minimum dollars Colorado can expect to save on direct medical costs (primarily paid through Medicaid) by the implementation of a primary seat belt law. The current study analyzed Colorado’s 2005 Hospital Discharge Data, including only cases where the external cause of injury was a motor vehicle crash. The total estimated costs to Medicaid, including Traumatic Brain Injury and Spinal Cord Injury costs, from motor vehicle crashes for the first year the injury was incurred for Colorado is $58.7 million for the first year and $7.7 million for each year after. In 2006, Colorado’s seat belt use rate was 80.3%. Based on a 40% expected conversion rate, one would expect belt use to increase by 7.88%, and of those newly belted individuals at least 50% would avoid injury (based on seat belt effectiveness in reducing injury). However, the Federal Government reimburses States a portion of their Medicaid expenditures. The reimbursement rate for Colorado is 50.0%. Accounting for this reimbursement, the first-year savings to the State by implementation of a primary seat belt law would be about $1.2 million dollars. Colorado could expect to have saved $7.3 million in the first 5 years and $18.2 million over 10 years.]]></description>
      <pubDate>Fri, 02 May 2008 16:15:18 GMT</pubDate>
      <guid>https://trid.trb.org/View/855906</guid>
    </item>
    <item>
      <title>Estimated Minimum Savings to the Medicaid Budget in Missouri by Implementing a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/855905</link>
      <description><![CDATA[A 2003 study estimated that if all States had primary laws from 1995 to 2002, over 12,000 lives would have been saved. Failure to implement a primary belt law creates a real cost to a State’s budget for Medicaid and other State medical expenditures. This study estimates the minimum dollars Missouri can expect to save on direct medical costs (primarily paid through Medicaid) by the implementation of a primary seat belt law. The current study analyzed Missouri’s 2005 Hospital Discharge Data, including only cases where the external cause of injury was a motor vehicle crash. The total estimated costs to Medicaid, including Traumatic Brain Injury and Spinal Cord Injury costs, from motor vehicle crashes for the first year the injury was incurred for Missouri was $132.6 million. For subsequent years, the cost is $30.7 million. In 2005, Missouri’s belt use rate was 77.4%. Based on a 40% belt use conversion rate for implementing a primary law, belt use could be expected to increase by 9.04% in Missouri. The Federal government also reimburses a portion of States’ Medicaid expenditures and the 2005 reimbursement rate for Missouri was 61.6%. Accounting for this reimbursement, in the first year after implementing a primary law Missouri could save $2.3 million. In terms of cumulative savings, over the next 10 years, Missouri can expect to save at least $46.8 million on their annual budget in medical costs alone by implementing a primary seat belt law in 2007.]]></description>
      <pubDate>Fri, 02 May 2008 16:15:05 GMT</pubDate>
      <guid>https://trid.trb.org/View/855905</guid>
    </item>
    <item>
      <title>Estimated Minimum Savings to the Medicaid Budget in Arkansas by Implementing a Primary Seat Belt Law</title>
      <link>https://trid.trb.org/View/855903</link>
      <description><![CDATA[A 2003 study estimated that if all States had primary laws from 1995 to 2002, over 12,000 lives would have been saved. Failure to implement a primary belt law creates a real cost to a State’s budget for Medicaid and other State medical expenditures. This study estimates the minimum dollars Arkansas can expect to save on direct medical costs (primarily paid through Medicaid) by the implementation of a primary seat belt law. The current study analyzed Arkansas’s 2005 Hospital Discharge Data, including only cases where the external cause of injury was a motor vehicle crash. The total estimated cost paid by Medicaid from motor vehicle crashes is $36 million for the first year and $6.7 million for each year thereafter. In 2005, Arkansas’s seat belt use rate was 68.3%. Based on this conversion rate one would expect belt use to increase by 12.68% and of those newly belted individuals, at least 50% would avoid injury. In 2005, The Federal Government reimbursed Arkansas at 73.37%. Accounting for this reimbursement, the first year savings to the State by implementation of a primary seat belt law would be about $0.6 million. Arkansas could expect to have saved $4.2 million in the first 5 years and $11.1 million over 10 years.]]></description>
      <pubDate>Fri, 02 May 2008 16:14:51 GMT</pubDate>
      <guid>https://trid.trb.org/View/855903</guid>
    </item>
    <item>
      <title>Orthopedic Trauma from Recreational All-Terrain Vehicle Use in Central Kentucky: A 6-Year Review</title>
      <link>https://trid.trb.org/View/809714</link>
      <description><![CDATA[The medical community has become increasingly concerned about all-terrain vehicle (ATV) injuries and crashes. An increase in injury and usage incidence has been tracked by the United States Consumer Product Safety Commission since federal guidelines expired in 1998. The authors retrospectively review central Kentucky ATV crash-related injury location, prevalence, and type from Level I trauma center data, and compare it with previously reported data. Data on individuals who sustained, between January 1998 and December 2003, ATV crash-related injuries, was analyzed for discharge destination, internal disposition, days in an intensive care unit (ICU), hospital stay duration, Functional Independence Measure (FIM), Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), injury location and type, insurance type, alcohol use, helmet use, and patient demographics. The study shows that predominately white (98%) males (85.4%) residing in rural counties (85.1%) were ATV-crash victims, who covered medical expenses through self-pay (31.4%) or commercial insurance (36.2%). 85.5% of crash victims were not wearing helmets at the time of the crash and 25% had documented pre-crash alcohol use. The primary ATV crash mechanism was rollover (63.3%). Loss of consciousness occurred in 52.1% of patients.  The most common injury locations of 707 total injuries were tibia-fibula (4.7%), radius-ulna (5.3%), clavicle (6%), ribs (24.1%), spinal dislocation (26%), and fracture (45.1%). Hospital stays for admitted patients were 8.1±12.7 days (range=0-127) of which 18.6% were immediately taken to the operating room, 28.2% were in the ICU 8.4±7.7 days (range=1-34 days), and 42% received standard care ward transfers. Prior to discharge, 4.8% of ATV-crash patients died. Of the remainder, after being discharged from the facility studied, 3.2% received transfers to another hospital, 12.8% received transfers to a rehabilitation facility, and 78.2% went home. Greater composite and component FIM and GCS scores and lower ISSs were enjoyed by patients who went home after discharge or who never lost consciousness. The authors conclude that the spine was the most prevalent location of joint dislocation or fracture, with almost half of all patients sustaining one of these injuries. Access to needed healthcare services may not be available to many patients as suggested by predominately rural residence locations, low rehabilitation facility referrals, and severity of injury. To asses health care system effectiveness, quality of life, and patient functional independence, prospective longitudinal outcome studies are needed.]]></description>
      <pubDate>Tue, 19 Jun 2007 08:27:40 GMT</pubDate>
      <guid>https://trid.trb.org/View/809714</guid>
    </item>
    <item>
      <title>Estimated Minimum Savings to a State's Medicaid Budget by Implementing a Primary Seat Belt Law: Arkansas, Colorado, Florida, and Missouri</title>
      <link>https://trid.trb.org/View/808990</link>
      <description><![CDATA[For front seat occupants of passenger cars, seat belts can reduce the risk of death by 45% and the risk of serious non-fatal injuries by 50%. One method proven to be successful in increasing belt use is enacting primary seat belt laws in States. According to the National Highway Traffic Safety Administration (NHTSA), passing a primary law can increase seat belt use rates among non-users by 40%. A primary seat belt law allows a police officer to issue a seat belt citation whenever they observe an unbelted front seat occupant. A secondary law allows police to only issue a seat belt citation if the vehicle has been stopped for another violation. Currently, only 25 States have primary laws. A 2003 study estimated that if all States had primary laws from 1995 to 2002, over 12,000 lives would have been saved. Failure to implement a primary belt law creates a real cost to a State’s budget for Medicaid and other State medical expenditures. NHTSA contracted with Preusser Research Group to examine the minimum estimated savings on direct medical costs paid through Medicaid if primary belt laws were implemented in four States: Arkansas, Colorado, Florida, and Missouri.  The findings are summarized in this Traffic Tech fact sheet.]]></description>
      <pubDate>Tue, 15 May 2007 14:31:38 GMT</pubDate>
      <guid>https://trid.trb.org/View/808990</guid>
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